[Long-Term Results of Computer-Navigated Total Knee Arthroplasties Performed by Low-Volume and Less Experienced Surgeon]. / Vplyv pocítacovej navigácie na dlhodobé výsledky po implantáciách totálnych endoprotéz kolenného klbu vykonaných menej skúseným operatérom.

PURPOSE OF THE STUDY The study aims to evaluate the long-term results of computer-navigated total knee arthroplasties performed by less experienced surgeon performing a small number of procedures per year. MATERIAL AND METHODS In the prospective randomised study functional and radiological results, rate of revision and probability of clinical and radiological survival were compared in 30 computer-navigated (in 28 patients: 19 women, 9 men, with the mean age of 66.9 years) and 31 conventionally implanted (in 30 patients: 27 women, 3 men, with the mean age of 66.5 years) cemented total knee replacements without patellar resurfacing. The group was composed of patients who underwent surgery performed by the same surgeon who at the time of enrolment of patient in the study had no previous experience with the total knee replacement surgery and performed up to 30 such procedures annually. The mean follow-up of patients was 11 years. RESULTS No statistically significant differences were detected regarding the mean age, sex, body mass index and etiology of osteoarthritis of the operated knee. The mean duration of computer-navigated surgeries (101±14.1; 80-140 min) was considerably longer than the duration of conventional joint replacements (94±8.2; 80-100 min; p = 0.01). When evaluating the radiological results, a statistically significant difference was found between the groups only with respect to the mean value of dorsal inclination of the tibial component (88.2˚±2.1 vs 86.2˚±3, p = 0.02). The mean values of other monitored angles did not show any significant differences. The number of correct implants (with a deviation of 3 degrees from the target values) was statistically significantly higher in the group of computer-navigated joint replacement surgeries in all the monitored parameters (aFT: 87% vs. 67%, p = 0.04; α: 87% vs. 71%, p = 0.04; ß: 87% vs. 65%, p = 0.03; γ: 93% vs. 74%, p = 0.02; δ: 90% vs. 77%, p = 0.04). Radiologic signs of unstable fixation were detected in 2 cases of computer-navigated joint replacement surgeries and in 7 cases of conventional replacements. Cumulative probability of radiologic survival at 10 years reached 93% in the compute-navigated surgery and 77.4% (p = 0.047) in the group with conventional procedure. In total, 4 revision surgeries with a reimplantation of at least one prosthetic component were reported. All the cases came from the conventional implantation group due to aseptic loosening of the endoprosthesis. In the computer-navigated group, one revision was performed for patellar pain, without replacing or adding any endoprosthetic component. The probability of clinical survival in computer-navigated replacements after 10 years was 100%, in conventional total knee replacements it was 87% (p = 0.04). The cumulative total endoprosthesis revision rate in the computer-navigated group was 3.3%, whereas in the group with conventional total knee replacements it was 12.9% (p = 0.04). The clinical assessment based on the WOMAC and Knee Society Scores showed no statistically significant differences. DISCUSSION The most common cause of the failure of total knee arthroplasties is the malposition of implants which results in early aseptic loosening. The radiologically correct position of knee endoprosthesis is seen in 80% of standard replacement surgeries performed by experienced surgeons. The potential error rate can even increase if the arthroplasties are performed by less experienced orthopaedic surgeons. The computer-navigated total knee replacement was introduced to make the position of implants more accurate. However, the question remains unanswered if more accurate positioning of the implants achieved with computer navigation decrease the revision rate and extend the long-term survival of knee endoprostheses. CONCLUSIONS Kinematic computer navigation allowed a less experienced and low-volume orthopaedic surgeon to make the implantation of endoprostheses more accurate, to decrease the total revision rate, and thus to ensure a higher probability of long-term survival of total knee arthroplasties. Key words:computer navigation, total replacement, knee joint, long-term outcomes, low-volume surgeon, less experienced surgeon.

[The incidence of osteopenia and osteoporosis in patients with cementless total hip arthroplasty]. / Incidencia osteopénie a osteoporózy u pacientov plánovaných na implantáciu necementovanej endoprotézy bedrového klbu.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. MATERIAL AND METHODS: The group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., fist, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence classification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. RESULTS: Osteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the fist time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSION Osteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent findings of osteopenia and osteoporosis in this study show that patients with osteoarthritis may not be protected from the development of generalised osteoporosis. Our results are compared with the relevant literature data and potential effects of osteoporosis and vitamin D deficiency on total hip arthroplasty are discussed. CONCLUSIONS: Hip osteoarthritis does not reduce the risk of generalised osteoporosis. We found a relative high incidence of osteopenia and osteoporosis as well as vitamin D deficiency in patient with advanced form of hip osteoarthritis.

[Bone Remodelling in the Proximal Femur after Uncemented Total Hip Arthroplasty in Patients with Osteoporosis]. / Kostná remodelácia proximálneho femuru po implantácii necementovanej endoprotézy bedra u pacientov s osteoporózou.

PURPOSE OF THE STUDY: The aim of the study was to investigate the involvement of osteoporosis during remodelling of the proximal femur after uncemented total hip arthroplasty (THA) and the effect of bisphospohonate treatment on these changes. MATERIAL AND METHODS: Sixty evaluated patients with non-cemented THA were divided into three groups on the basis of pre-operative densitometric examinations. Group 1 (15 patients with osteoporosis) received a single dose of 5 mg zoledronic acid in infusion during the second post-operative week. Group 2 (15 patients with osteoporosis) were not treated by bisphospohonate. The patients of both groups took oral calcium and vitamin D medication. Group 3 (control) comprised 30 patients with normal bone density who did not take any osteoactive drugs. By measurement of bone mineral density (BMD) at 12 months after surgery, changes in periprosthetic bone of the proximal femur in 7 Gruen zones were recorded by densitometry. In addition, radiological findings on native X-ray images were assessed and the patients' clinical health status was rated by the Harris hip score. RESULTS: No significant differences in either the average age or the body mass index were found between the groups at the time of THA surgery. The mean BMD value in all assessed Gruen zones measured at the first post-operative week was higher in patients with normal bone density than in those with osteoporosis. The mean BMD value measured at 12 months decreased in all Gruen zones in comparison with the initial value, and this was found in all three groups. The lowest values were recorded in the untreated patients (group 2); in comparison with the patients who had normal bone density, the difference was statistically significant in Gruen zones 1, 2, 6 and 7. Although the patients with treated osteoporosis also showed lower BMD values, these were not statistically significant compared to group 3. The worst post-operative outcome in clinical health status was recorded in the patients with untreated osteoporosis. X-ray examination revealed stable fibrous ingrowth in one patient with untreated osteoporosis and in one with normal bone density. All remaining patients had stable bone ingrowth fixation. DISCUSSION: In THA the majority of compressive loads are transferred through the stem to the femoral bone below the apex of the stem. This results in reduction of bone density in the calcar and greater trochanter regions. Osteoporosis is the most important factor related to changes in periprosthetic bone mass. Therefore, it can be anticipated that an excess loss of bone mass in the proximal femur may, in a long term, interfere with THA stability and may increase the risk of periprosthetic fractures and aseptic loosening. CONCLUSIONS: The results of our study showed that the patients with untreated osteoporosis, who underwent uncemented THA, experienced a considerable decrease in the periprosthetic bone density of the proximal femur and were in worse clinical health. A bisphospohonate therapy was effective in eliminating this negative outcome. Both the clinical and densitometric findings in patients with treated osteoporosis were similar to those in patients with no osteoporosis.

[Our experience with the metha short hip stem]. / Nase skúsenosti s krátkym femorálnym driekom Metha.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the clinical and radiographic results of total hip arthroplasty (THA) with the Metha short hip stem and their comparison with the outcomes of THA using a conventional cementless stem. MATERIAL AND METHODS: A total of 30 Metha stems and 30 standard Biocontact stems implanted in the period from 2007 to 2012 were evaluated. The Metha patient group comprised 22 women and six men, with the mean age of 58.9 ± SD 8.7 years (43-75), mean height of 164.2 ± 6.3 cm (156-178), mean body mass of 68.2 ± 12 (48-91) and mean BMI of 25 ± 3.9 (19-32). The Biocontact group included 19 women and 11 men, with the mean age of 63.6 ± 10.8 years (45-77), mean height of 166.6 ± 6.6 cm (152-175), mean body mass of 77.6 ± 13.1 (46-104) and mean BMI of 27.6 ± 4.3 (20-37). The evaluation was based on plain X-ray findings and clinical status assessed using the Harris hip score and 10-point visual analogue scale (VAS) for pain before surgery and at final follow-up. RESULTS: In the Metha group the mean pre- and post-operative Harris hip scores were 41.7 ± 9.9 (28-57) and 94.4 ± 5.1 (82-100), respectively. In the Biocontact group the values were 41.5 ± 11.9 (32-64) and 89.3 ± 11.2 (57-100), respectively. The mean VAS for low back and thigh pain improved from the pre-operative value of 7.41 ± 2.1 (4-9) to 0.56 ± 1.0 (0-3) in the Metha group and from 7.29 ± 2.2 (4-9) to 1.64 ± 1.8 (0-5) in the Biocontact group. The post-operative results in both rating systems were significantly better (p<0.05) in the Metha than the Biocontact group patients. All stems showed radiographic evidence of good osteointegration. Stem subsidence and calcar atrophy were recorded in one patient of the Metha group. In the Biocontact group stem subsidence was found in two patients and signs of stress shielding in 14 patients. DISCUSSION: Short hip stems have been introduced in THA implantation with the aim to restore physiological biomechanics as much as possible and to ensure good long-term functioning of the joint replacement as well as to save the proximal femoral bone tissue for potential THA re-implantation. Our results of short hip stem implantation presented in this study are compared with the results of relevant recently published literature. CONCLUSIONS: Short hip stems show adequate osteointegration without need for diaphyseal fixation and allow for more natural weightbearing distribution in the proximal femur. The short- and mid-term clinical results are better than with the use of conventional cementless stems. They can be recommended as an optimal choice for use in younger patients with good bone quality who are expected to require THA re-implantation.

[Subtalar dislocation of the foot]. / Luxatio pedis subtalo.

PURPOSE OF THE STUDY: Based on a retrospective analysis, the authors present their experience with treatment of subtalar dislocation of the foot. MATERIAL AND METHODS: Between 1999 and 2011 six patients, all of them men, with the average age of 31 years were treated for subtalar fractures. Five patients were diagnosed with medial dislocation and one with lateral dislocation. In one patient with medial subtalar dislocation it was an open injury. The clinical and radiographic results of the patients followed up for 1 to 12 years (average, 7.8 years) were retrospectively evaluated. RESULTS: The achieved average score, based on the AOFAS ankle and hindfoot scale, was 91.3 points (± 9.77; minimum, 73; maximum, 100). Excellent results were recorded in four patients, good in one and satisfactory in the patient with lateral dislocation. Radiographic signs of subtalar joint osteoarthritis were found in one patient. No neurological or circulation dis - orders, skin necrosis, signs of reflex sympathetic dystrophy, aseptic bone necrosis of the talus, infection or joint instability were recorded. DISCUSSION: A subtalar dislocation of the foot involves simultaneous dislocation of the talocalcaneal and talonavicular joints. It is a rare injury accounting for about 1 to 2% of all traumatic dislocations. It may occur as medial, lateral, anterior or posterior subtalar dislocation. The results of treatment depend on several factors, such as the type of dislocation (medial and open dislocations are at higher risk), associated injuries, or damage to deep skin layers, and also on an exact diagnosis, early and accurate reduction and sufficiently long foot immobilisation.

[Magnetic resonance imaging in the diagnosis of intra-articular lesions of the knee]. / Prínos MRI v diagnostike intraartikulárnych lézií kolenného klbu.

PURPOSE OF THE STUDY: Magnetic resonance imaging (MRI) has the highest sensitivity of all methods for the diagnosis of intra-articular knee injuries. In spite of this, its benefit for the decision-making algorithm is questionable. The aim of this study was to evaluate the real situation in our regional conditions. MATERIAL AND METHODS: The medical records of the patients who underwent knee arthroscopy in 2008 and 2009, and had pre-operative MRI examination, were retrospectively reviewed. The group included 92 patients (46 women and 46 men; average age, 41.7 years) of whom 49 had knee injury in their medical history. RESULTS: In medial meniscus (MM) injuries, the MRI examination had a sensitivity of 0.92 and a specificity of 0.44, and the congruence of MRI and arthroscopic findings was 0.73. In lateral meniscus (LM) tears, the values were 0.70 for sensitivity, 0.81 for specificity and 0.87 for congruence. In injury to the anterior cruciate ligament (ACL), MRI sensitivity was 0.66, specificity was 0.85 and congruence was 0.79. In evaluation of articular chondral lesions, the values were 0.45 for sensitivity, 0.87 for specificity and 0.60 for congruence. DISCUSSION: In our examination of knee structures for MM, LM, ACL and cartilage injuries, the diagnostic value of MRI was lowest for cartilage damage, with sensitivity being only 0.45. This was in agreement with the findings of other authors. Although this fact is known, our arthroscopic findings in patients with no MRI evidence of injury were very high: 22 knees with grade III or grade IV chondral lesions. Therefore, MRI examination is not considered to be sensitive enough to replace arthroscopy in the diagnosis of cartilage injuries. MRI examination is most frequently indicated in suspected meniscal damage. Its sensitivity reported in the literature varies; generally, it is about 0.90 in MM injuries, and about 0.75 in LM lesions, and this is in agreement with our results. However, in view of our previous experience, the high sensitivity of MRI in the diagnosis of MM lesions was an unexpected finding. A detailed statistical analysis showed that its high value was at the expense of a relatively high negative positivity (0.56) and a low predictive value of the positive test (0.65). In LM injuries these values were even worse: in addition to low sensitivity (0.70), the predictive value of the positive test was only 0.50. In the diagnosis of ACL injuries, MRI examination is reported to have a high sensitivity ranging from 0.85 to 0.90. This study showed poorer results; sensitivity was 0.66 and the predictive value of the positive test was 0.62. For injuries in which the orthopaedist is sure about the diagnosis and indicates arthroscopy, it is doubtful to indicate also MRI examination. This should be reserved for clinical presentations that are not clear, for post-operative conditions, serious knee injuries or combined injuries. However, patients with chronic problems and unclear clinical presentations should benefit from MRI examination which can make the diagnosis more accurate and thus reduce the number of arthroscopic procedures done entirely for diagnostic purposes. CONCLUSIONS: There is no consensus regarding the role of MRI in the diagnosis of intra-articular lesions of the knee. To a certain extent, its use is related to local conditions. It can be concluded that MRI examination is not currently as important for the diagnosis of knee injuries as expected by both medical and lay communities.

[Acute injuries of lateral ankle joint ligaments]. / Akútne poranenia laterálneho väzivového aparátu clenkového klbu.

Acute injuries of the lateral ankle ligaments are one of the most common form of injury involving the musculoskeletal apparatus. Treatment usually range from cast immobilisation or acute surgical repair to functional rehabilitation. The aim of our study was to evaluate the incidence of different grades of acute injuries of lateral ligaments of the ankle joint in our patients group and to compare the results of non surgical versus surgical treatment of third grade injuries. 3148 patients were treated for acute lateral ankle sprain in a period of 5 years at our department. Each patient had stress X-ray of the ankle for evaluation of instability at the first visit. From the 234 patients with third grade injury, 39 were enrolled in our study with non surgical treatment and 18 with surgical treatment. Each group was divided regarding to the age in two subgroups. Functional outcome was evaluated 12 and 24 months after injury with AOFAS clinical rating scale and Sports Ankle Rating System--Single Assessment Numeric Evaluation. Statistical analysis was done with Pearson's Chi quadrate test with P < 0.05. First grade injury was present in 62%, second grade in 31% and only 7% of the patients had third grade injury of the lateral ankle ligaments. Further only third grade injuries were studied. Statistically significant better results were seen in patients under the age of 25, in the patient group with surgical treatment compared to patients over 25 years of age. Also statistically significant better results were seen in patient with surgical treatment to non surgical treatment in each age group. No significant difference was observed in the non surgical treatment group regarding to age. Although the injuries of the ankle ligaments belong to the most common injuries of the musculoskeletal system, there is no consensus in the treatment of such disorders. Our experiences and the results of our study show, that surgical treatment in indicated cases provides better results in residual pain and instability of the ankle joint after acute injury of the lateral ankle ligaments.;

Effects of static magnetic field and pulsed electromagnetic field on viability of human chondrocytes in vitro.

Effects of electromagnetic fields (EMFs) on human cell lines were described in numerous studies, but still many questions remain unanswered. Our experiment was designed with the aim of studying the effects of EMFs on the metabolic activity of chondrocytes in vitro. Human chondrocyte in vitro cultures, cultured in medium supplemented with 20 % fetal calf serum, were exposed to static magnetic field (SMF) (intensity of 0.6 T) and pulsed electromagnetic fields (PEMF) (21.2 MHz period of 15 ms, burst duration of 2 ms, amplification 3 dBm (0.1 V) and maximum output of 250 W) continually for 72 h. After the exposure, viability was determined using the MTT test and compared with a non-exposed control culture. As compared to the control sample the exposure to SMF resulted in a statistically significant increase (p 0.001) in viability. However, the increase of viability after PEMF exposure was not significant. This could be due to the frequency dependent effect on human cells. The experiments demonstrated that magnetic fields, using the above parameters, have a positive effect on the viability of human chondrocytes cultured in vitro.

[Repair of chondral defects of the knee using a combination of autologous chondrocytes and osteochondral allograft--an animal model. Part I: in vitro culture of autologous chondrocytes]. / Reparácia chondrálneho defektu kolena kombináciou autológnych chondrocytov a osteochondrálnych alostepov--animálny model. I. Cast: in vitro kultivácia autológnych chondrocytov.

PURPOSE OF THE STUDY: In the study we used in vitro cultivated autologous chondrocytes in combination with osteochondral allografts for the treatment of local defects of articular cartilage on the animal model (rabbit). MATERIAL: Chondrocytes for in vitro cultivation were harvested by biopsy of articular cartilage of rabbit. For the monolayer cultivation we used Nutrient mix F 12 (Gibco BRL) with addition of Lascorbic acid (50 micrograms/ml, Sigma) and insulin-trasferin-selenium (A 6.26 micrograms/ml, Gibco BRL), 20% of fectal serum (Gibco BRL) and antibiotic antimycotic solution (Gibco BRL). Cultivation of chondrocytes took place at 37 degrees in the atmosphere of 5% CO2. Multiplied chondrocytes re-suspended in fibrin glue in combination with two osteochondral allografts were used for the reparation of artificial defect of the rabbit cartilage. METHODS: For the analysis of collagen type II in the cultivation medium we used the principle of salting out by 30% ammonium sulphate and subsequent pepsinization in an acid environment with a repeated salting out by means of 2M of NaCl. Precipitates were dissolved in 5.0 M of acetic acid and used for SDS PAGE and immunoblotting. As a detection system we used ECL (Amersham/Pharmacia Biotech). RESULTS: The final average number of chondrocytes multiplied by monolayer cultivation was 1.10(5). The presence of collagen of type II has proved the preservation of the original phenotype of chondrocytes during cultivation. DISCUSSION: Bioengineering use of cell and tissue cultivation provides new options of the treatment of defect of connective tissue. Transplantation of autologous chondrocytes in combination with osteochondral allografts is on the basis of our results obtained so far a promising therapy. CONCLUSION: The aim of our work was an ex vivo expansion of autologous chondrocytes for the purpose of cell transplantation.

[Evaluation of replantations with regard to duration of treatment and sick-leave.]. / Hodnotenie replantácií vo vztahu k dobe liecenia a práceneschopnosti.

The authors compare results of replantations performed at the Orthopaedic Clinic of the Medical Faculty, Safarik University in Kosice, Replantation Centres in Austria (which are part of traumatological hospitals) and results of replantations at the Clinic of Plastic and Aesthetic Surgery in Brno. They base their evaluation on the number of the survival of replants, period of treatment and sickleave. In the course of 7 years (1991 through 1997) there were 157 patients operated on at the Orthopaedic Clinic of the Medical Faculty, Safarik University in Kosice for replantation and revascularization. The success rate of replantations has in the recent years increased from 72 % to 95 %. Six Replantation Centres in Austria report 286 such surgeries in the period of 10 years (1977-1987), the Clinic of Plastic and Aesthetic Surgery in Brno reports 649 surgeries of this type in the course of 10 years (1982-1992) with 81 % success rate. The mean period of hospitalization of patients including physical therapy is approximately the same both in the Austrian centres and at the Orthopaedic Clinic of the Medical Faculty Safarik University in Kosice. Also the period of sick-leave is roughly the same ranging between 4 and 5 months. Key words: replantation outcomes, period of hospitalization, period of sick-leave.

[Iatrogenic gonitis.]. / latrogénne gonitídy.

The authors draw attention to the problem of iatrogenic gonitis. They analyze the causes of their development and draw attention to the possible negative effect of intraarticular therapy in patients with affections of the joints in orthopaedics. During the past seven years they recorded 54 cases of purulent iatrogenic gonitis after administration of corticoids and chondroprotective substances administered in out-patient departments. They emphasize the very rapid therapeutic effect of corticoids, while also side-effects of these preparations must be taken into consideration, in particular the development of pyogenic arthritis. Only satisfactory knowledge of the topographic anatomy, physiological and pathological conditions in the joints and the pharmacological effect of the preparations and knowledge of the basic principles of intraarticular treatment justify the doctor to use these procedures. Key words: intraarticular treatment, pyogenic iatrogenic arthritis.

[Absorbable materials in orthopaedic surgery.]. / Vstrebatel'né materiály v ortopedickej chirurgii.

The authors discuss the use of biodegradable in vivo absorbable osteosynthetic material BIOFIX manufactured by BIOSCIENCE Ltd. Tampere Finland. They describe its composition, indications, contraindications of its use, possible complications as well as advantages of its use in orthopaedics, traumatology and microsurgery. They present their initial experience with osteosynthesis of fractures with Biofix in the talocrural joint, shoulder and elbow. Key words: fractures of the ankle, osteosynthesis, Biofix.

[Secondary and tertiary endoprosthesis of the hip joint.]. / Sekundárna a terciálna endoprotéza bedrového klbu.

The authors analyze mechanical and biological causes of loosening of cemented total endoprosthesis of the hip joint. They reflect on the "most suitable" time of reoperation, based on clinical experience and the X-ray finding. The authors investigated on account of loosening of the first and second endoprosthesis of the hip joint resp. a group of 28 patients. They present an account of their experience with some new non-cemented types of prostheses during primary or secondary revisions of total prostheses of the hip joint. Key words: total endoprosthesis of the hip joint, aseptic loosening, reimplantation of a total endoprosthesis of the hip joint, secondary and tertiary endoprosthesis of the hip joint.

[Iatrogenic gonitis.]. / latrogénne gonitídy.

The authors pay attention to problems of iatrogenic gonitis. They analyze the causes of their development, draw attention to possible negative influences of intraarticular treatment in patients with articular affections in the field of orthopaedics. During the last seven years thy recorded 34 cases of purulent iatrogenic gonitis after ambulatory administration of corticoids and chondroprotective substances. They emphasize the very good and rapid therapeutic effect of corticoids, however, it is important to consider also side-effects of preparations, in particular possible development and progression of pyogenic arthritis. Only good knowledge of topographic anatomy, physiological and pathological relations in the joint, pharmacological of action preparations, knowledge of basic principles and principles of intraarticular treatment justifies doctors to perform these operations. Key words: intraarticular treatment, pyogenic iatrogenic arthritis.

[Intrapelvic migration of a total hip prosthesis in rheumatoid arthritis]. / Intrapelvická migrácia totálnej endoprotézy bedrového kíbu pri reumatoidnej artritíde.

The authors discuss the risk of mechanical loosening and protrusion of a cemented endoprosthesis of the hip joint after operation which is one of the few possibilities of palliative treatment in patients with rheumatoid arthritis. They deal in particular with specific features of surgical approaches whereby they select a modified method described by Eftekhar which makes it possible to resolve even severe grades of intrapelvic migration of the socket of a total endoprosthesis. The authors discuss possible complications which can be prevented if the relationship of intrapelvic structures to the protruded prosthesis is elucidated before operation. In a group of 1268 patients operated there were three with intrapelvic migration of a total endoprosthesis of the hip joint.

[Use of autologous veins and streptokinase in vascular complications after replantation of the right forearm]. / Pouzitie autovény a streptokinázy pri cievnych komplikáciach po replantácii pravého predlaktia.

The authors present the case-history of a 20-year-old worker with an amputation of the forearm in the distal third. After shortening of the bone by 2.5 cm and osteosynthesis by means of grooved splints the blood vessels of the forearm were reconstructed by means of three autoveins. After 12 hours venous and arterial thrombosis developed. During reoperation the thrombotic portions of the vessels were resected and were again reconstructed by means of new autovenous grafts. Streptokinase was instilled into the amputate via the ulnar artery. During the subsequent postoperative period no serious vascular complications developed. Lymphorrhea persisted for some two weeks. To achieve satisfactory function of the hand a corrective operation will be necessary.

[The fate of patients after surgical revision of 3 intervertebral spaces in lumbo-ischiadic syndrome]. / Osud pacientov po chirurgickej revízii troch medziodstavcových priestorov pre lumboischiadický syndróm.

The authors present a report on 9 patients (out of which five were female and four male patients) in the age group ranging from 34 to 55 years, who underwent in the period between 1 January 1982 and 31 December 1987 the revision of three intervertebral spades due to the unilateral lumbo-ischiadic syndrome. Operations of such an extent were performed only exceptionally, in case clinical symptoms and myelographic or CT examination proved the lesion of three intervertebral discs. Ensuing from the control examination performed in November 1988 two patients have been invalided and the rest of them working on a full load (five of them doing their original job and two doing a new one). Almost all of them suffer from occasional pain in sacrum and - but for one exception - also in the lower extremity. Only in one case (a female patient) the condition has not improved after the operation. The recovery of working ability has been in most cases facilitated also by spa treatment.